Provider Demographics
NPI:1902420797
Name:PYLES, CAREY DANEAL
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:DANEAL
Last Name:PYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 HOGARDS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8871
Mailing Address - Country:US
Mailing Address - Phone:270-572-1350
Mailing Address - Fax:
Practice Address - Street 1:869 HOGARDS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8871
Practice Address - Country:US
Practice Address - Phone:270-572-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities